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The Intensive Care Unit is an area of the hospital that can elicit high levels of emotional and spiritual distress due to high mortality and prognostic uncertainty. Religion and spirituality are often manifest through prayer, rituals, and ceremonies, which can unite the patient and family with the care team. However, miracle language and other religious or spiritual topics that misalign with the expectations of the medical team can also lead to discord. The acute nature of ICU care poses challenges in creating a therapeutic alliance necessary to effectively address the religious and spiritual needs of patients and families. In this chapter, we provide a practical approach to provide high quality spiritual care in the ICU.

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